RESUMEN
It has been well established that organ transplant recipients (OTRs) are at an increased risk of skin cancer. Studies vary on the exact degree of this risk, but it is likely somewhere between 60 and 100 times more likely that an OTR patient will develop skin cancer. The management of skin cancer burden in OTRs requires a multidisciplinary approach with the transplant team, dermatologists, and oncology. In many major hospital systems, there are dedicated transplant dermatology clinics that allow for specialized and more frequent screenings of this high-risk population. Here we discuss the pathogenesis, presentation, and treatment options used by dermatologists to prevent and treat commonly found skin cancers in this vulnerable population.
Asunto(s)
Carcinoma de Células Escamosas , Trasplante de Órganos , Neoplasias Cutáneas , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/prevención & control , Humanos , Trasplante de Órganos/efectos adversos , Factores de Riesgo , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/etiología , Receptores de TrasplantesRESUMEN
Ocrelizumab is a humanized CD20 monoclonal antibody which was approved for management of Relapsing Remitting Multiple Sclerosis (RRMS) and Primary Progressive Multiple Sclerosis (PPMS) in 2017. We present 2 patients, a 67-year-old woman with history of PPMS and a 42-year-old woman with RRMS, who were started on ocrelizumab and were diagnosed with invasive ductal cell breast carcinoma after 2 years of ocrelizumab infusion followed by discontinuation of the drug. Large trials conducted for ocrelizumab showed malignancies in a total of 4 cases with RRMS in OPERA 1 trial conducted over 2 years from 2011 to 2013 (breast cancer, renal cell carcinoma, and melanomas) and in 11 cases with PPMS seen in ORATORIO trial conducted in 2017. There are currently no other published case reports of breast cancer in setting of ocrelizumab use for MS outside of large trials on literature review.
Asunto(s)
Dermatología , Médicos , Conflicto de Intereses , Humanos , Práctica Privada , Estados UnidosRESUMEN
There are multiple, genetically distinct pathways that give rise to melanoma. Melanomas on sun-damaged skin (MSDS), including lentigo maligna and desmoplastic melanoma, have distinct genetic profiles and are uniquely linked to chronic ultraviolet exposure. In this article, we discuss the etiologies of lentigo maligna and desmoplastic melanoma, emerging diagnostic adjuncts that might be helpful for accurately identifying these lesions, and the clinical relevance of their frequent co-occurrence. We present unique and overlapping features of these entities and discuss challenges in MSDS management, including margin assessment, excision, and the potential role of nonsurgical therapy. Last, we address the role of immunotherapy in invasive disease. Understanding MSDS as distinct from melanoma arising on intermittently sun-exposed or sun-protected skin will ultimately help optimize patient outcomes.
Asunto(s)
Peca Melanótica de Hutchinson/diagnóstico , Neoplasias Cutáneas/diagnóstico , Piel/patología , Luz Solar/efectos adversos , Antígeno B7-H1/genética , Biopsia , Procedimientos Quirúrgicos Dermatologicos , Dermoscopía , Diagnóstico Diferencial , Humanos , Peca Melanótica de Hutchinson/etiología , Peca Melanótica de Hutchinson/terapia , Imiquimod/uso terapéutico , Inmunoterapia/métodos , Márgenes de Escisión , Microscopía Confocal , Tasa de Mutación , Invasividad Neoplásica/genética , Invasividad Neoplásica/patología , Neurofibromina 1/genética , Proteínas Proto-Oncogénicas c-kit/genética , Radioterapia Adyuvante , Ensayos Clínicos Controlados Aleatorios como Asunto , Piel/diagnóstico por imagen , Piel/efectos de la radiación , Envejecimiento de la Piel/patología , Envejecimiento de la Piel/efectos de la radiación , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/terapia , Resultado del TratamientoRESUMEN
Despite the successful assignment of Current Procedural Terminology codes, there are barriers to incorporating in vivo reflectance confocal microscopy (RCM) into daily practice. Importantly, the dermatopathologist can play a key role in interpreting RCM images and can use these images to correlate with histopathology. Herein, we describe, using a case series, how RCM can be incorporated into the dermatopothalogist's practice. We also summarize the criteria for RCM diagnosis of common neoplasms.
Asunto(s)
Dermatología/métodos , Microscopía Confocal/métodos , Patología Clínica/métodos , Neoplasias Cutáneas/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Lipoptena cervi, known as the deer ked, is an ectoparasite of cervids traditionally found in northern European countries such as Norway, Sweden, and Finland. Although rarely reported in the United States, this vector recently has been shown to carry Borrelia burgdorferi and Anaplasma phagocytophylum from specimens collected domestically. Importantly, it has been suggested that deer keds are one of the many disease-carrying vectors that are now found in more expansive regions of the world due to climate change. We report a rare sighting of L cervi in Connecticut. Additionally, we captured a high-resolution photograph of a deer ked that can be used by dermatologists to help identify this disease-carrying ectoparasite.
Asunto(s)
Borrelia burgdorferi/aislamiento & purificación , Ciervos/parasitología , Dípteros/microbiología , Adulto , Animales , Connecticut , Vectores de Enfermedades , Humanos , MasculinoRESUMEN
Several new monoclonal antibodies that interfere with interleukin (IL) cascades have come to market in recent years. They follow a generation of drugs that block tumor necrosis factor (TNF). It has been well established that TNF is important in the containment of Mycobacterium tuberculosis (Mtb) and that blocking this cytokine increases the risk of tuberculosis (TB) infection. Thus, judicious screening for Mtb of patients taking TNF blocking drugs has been the standard of care. It remains unclear if the newer monoclonal, interleukin blocking drugs, which affect IL-12, IL-23, and IL-17 pathways are associated with risk of Mtb reactivation. Herein we discuss what is known about the immunologic response to Mtb and discuss the data that is currently available for the new interleukin monoclonal antibody blocking medications regarding the risk of latent TB reactivation or active TB infection.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Interleucinas/antagonistas & inhibidores , Tuberculosis Latente/inducido químicamente , Tuberculosis Latente/diagnóstico , Humanos , Tuberculosis Latente/fisiopatología , Mycobacterium tuberculosis , Factores de Riesgo , Tuberculosis/fisiopatologíaRESUMEN
Systemic amyloidosis is a rare disease that can be rapidly progressive due to widespread organ involvement. There are well-described renal, cardiac, pulmonary, neurological, and dermatologic findings. Here, we outline one patient's experience with the condition from presentation to making the diagnosis. She presented with pathognomonic dermatologic findings including pinch purpura and ecchymoses found in the skin folds.